On Nov. 20, the U.S. Department of Health and Human Services published proposed rules outlining health insurance issuer standards related to the coverage of essential health benefits (EHB) and the determination of actuarial value (AV).

The Patient Protection and Affordable Care Act requires health plans offered in the individual and small-group markets to offer a core package of items and services known as EHB. The proposed rules include a number of standards to protect consumers against discrimination and ensure that benchmark plans offer a full array of benefits. Under the rule, states must select a benchmark plan from among several pre-identified options. In the event a state does not choose a benchmark plan, HHS will select a default plan on behalf of the state. Additionally, all plans covering EHB must offer benefits substantially equal to the benefits offered by the selected benchmark plan.

The proposed rules also address AV, which represents the percentage of total average costs for benefits a plan will cover. Beginning in 2014, non-grandfathered health plans in the individual and small-group markets must meet certain AV or "metal levels." Metal levels are intended to help consumers make an informed decision by allowing them to compare plans with similar levels of coverage. The proposed rules provide greater flexibility by allowing a plan to meet a particular metal level if its AV is within 2 percentage points of the standard. To assist consumers in this process, HHS introduced a publicly available AV calculator. The proposed calculator is posted on the Center for Consumer Information and Insurance Oversight website, which can be found at cciio.cms.gov/resources/regulations/ index.html.